Site Navigation

Site Mobile Navigation

The Health Law Mandate

“White House Set to Shape Debate Over Health Law” (front page, March 9), about the Supreme Court’s hearings on the health law, doesn’t mention an important new argument against the Affordable Care Act’s mandated purchase of private insurance, the key issue before the Supreme Court.

Last month, an amicus brief was filed by 50 doctors and two nonprofit organizations arguing that Congress could avoid a mandate by legislating a national single-payer system that provides nearly universal insurance coverage.

Congress has already created two limited single-payer systems — Medicare and the veterans’ health system — and no legal barriers prevent doing more. Since a mandate isn’t necessary for Congress to exercise its legitimate role in regulating health insurance, there is no justification under the Constitution’s “necessary and proper” clause for such a legislative requirement.

How this argument will influence the court remains to be seen. But the brief is another reminder that the single-payer idea, although currently off the table in Washington, should not be counted out.

ARNOLD S. RELMAN
Cambridge, Mass., March 9, 2012

The writer, professor emeritus of medicine and social medicine at Harvard Medical School, is a former editor in chief of The New England Journal of Medicine.